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Rapid Access Cardiology Clinics (RACC)–Assessing Cardiovascular Risk
Abstracts
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111 Rapid Access Cardiology Clinics (RACC)–Assessing Cardiovascular Risk H. Klimis 1,2,3,∗ , A. Thiagalingam 1,2 , M. Bartlett 1 , M. Altman 1 , D. Wynne 1 , R. Denniss 1,2,4 , N. Cheung 2,5,6 1 Department of Cardiology, Westmead Hospital, Sydney, Australia 2 University of Sydney, Sydney, Australia 3 The George Institute for Global Health, Sydney, Australia 4 Western Sydney University, Sydney, Australia 5 Clinical Lead, Western Sydney Integrated Care Programme, Sydney, Australia 6 Department of Endocrinology, Westmead Hospital, Sydney, Australia
Background: RACC, as part of the Western Sydney Integrated Care Programme (WSICP), was established as a hospital admission diversion strategy to manage lowintermediate risk chest pain. Our objective was to examine the cardiovascular (CV) risk factor burden of patients presenting to RACC. Methods: Clinical and lifestyle risk factor data were collected for consecutive patients presenting to RACC. Results: In the first 12 months, among 520 chest pain patients (55% male, mean age 55.2 years) assessed, 12% had pre-existing coronary heart disease (CHD) and 8% were diagnosed with new CHD. Among the 414 without CHD, 89(22%) were high CV risk according to a Framingham risk calculator, 43(10%) moderate, and 282(68%) low risk. At presentation 1.7% had chronic renal failure, 22% had HbA1c ≥ 6.5%, 70% had LDL-C ≥ 2 mmol/L, 32% had SBP ≥ 140 mmHg, 79% overweight (mean BMI 29.7 ≥ 6.7 kg/m2 and mean waist circumference was 101 cm), 33% had a family history of premature CHD, and 21% were current smokers or quit within the last 12 months. Also 81% exercised below Australian Heart Foundation guidelines, 82.3% ate less than the daily recommendations of vegetables, and 49% ate less than the daily recommendations of fruit each day. Overall 81% had 2 or more CV risk factors, and the mean number of CV risk factors (diabetes, smoker, hypercholesterolaemia, hypertension, family history, CRF, known CHD, elevated waist circumference) was 2.8. Conclusions: Many patients referred to RACC with chest pain have a high burden of uncontrolled risk factors. Thus, RACCs may bring new opportunities for modifiable risk factor optimisation and cardiovascular disease prevention. http://dx.doi.org/10.1016/j.hlc.2017.06.112
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112 Recurrent 12-Month Myocardial Infarction Rates in Patients Discharged with Acute Coronary Syndrome: A Retrospective Analysis from a Regional Referral Centre F. Zaky ∗ , A. Ekmejian, O. Evans, C. Lynch, S. Dejanipont, P. Shetty The Wollongong Hospital, Wollongong, Australia Background: The Wollongong Hospital is a regional referral centre admitting approximately 900 Acute Coronary Syndromes (ACS) patients per year. Recent advances with potent thienopyridines has reduced recurrent ischaemia rates significantly, which has led to a consensus statement in recent guidelines. Our local policy continues to evolve, however current strategies use aspirin/clopidogrel as the main dual antiplatelet strategy post ACS. Methods: 886 patients presented to Wollongong Hospital with ACS between January and December 2016, most whom were discharged home on an aspirin/clopidogrel regimen. Medical records of these patients were retrospectively reviewed for recurrent myocardial infarction (MI) within one year. Data was collected on traditional coronary artery disease risk factors, previous revascularisation procedures, anti-platelet regimen, time to representation and subsequent requirement for re-vascularisation. Results: Of 886 patients presenting with ACS in 2016, 2.3% (n = 20) represented with an MI within one year. Of these 20 representations, 85% of patients (n = 17) were on aspirin and clopidogrel dual anti-platelet therapy. 95% (n = 19) of patients had prior re-vascularisation procedures, 55% (n = 11) through percutaneous coronary intervention (PCI). 55% (n = 11) of representations were managed medically after angiography, with 45% (n = 9) subsequently requiring bypass or PCI. Conclusion: Recent trials have shown that recurrent ischaemic rates are substantially higher in patients treated with aspirin/clopidogrel than combinations including more potent thienopyridines, however in our cohort re-presentation rates in patients on aspisin/clopidogrel were found to be very low, with a low requirement for subsequent procedural re-vascularisation. http://dx.doi.org/10.1016/j.hlc.2017.06.113
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111 Rapid Access Cardiology Clinics (RACC)–Assessing Cardiovascular Risk H. Klimis 1,2,3,∗ , A. Thiagalingam 1,2 , M. Bartlett 1 , M. Altman 1 , D. Wynne 1 , R. Denniss 1,2,4 , N. Cheung 2,5,6 1 Department of Cardiology, Westmead Hospital, Sydney, Australia 2 University of Sydney, Sydney, Australia 3 The George Institute for Global Health, Sydney, Australia 4 Western Sydney University, Sydney, Australia 5 Clinical Lead, Western Sydney Integrated Care Programme, Sydney, Australia 6 Department of Endocrinology, Westmead Hospital, Sydney, Australia
Background: RACC, as part of the Western Sydney Integrated Care Programme (WSICP), was established as a hospital admission diversion strategy to manage lowintermediate risk chest pain. Our objective was to examine the cardiovascular (CV) risk factor burden of patients presenting to RACC. Methods: Clinical and lifestyle risk factor data were collected for consecutive patients presenting to RACC. Results: In the first 12 months, among 520 chest pain patients (55% male, mean age 55.2 years) assessed, 12% had pre-existing coronary heart disease (CHD) and 8% were diagnosed with new CHD. Among the 414 without CHD, 89(22%) were high CV risk according to a Framingham risk calculator, 43(10%) moderate, and 282(68%) low risk. At presentation 1.7% had chronic renal failure, 22% had HbA1c ≥ 6.5%, 70% had LDL-C ≥ 2 mmol/L, 32% had SBP ≥ 140 mmHg, 79% overweight (mean BMI 29.7 ≥ 6.7 kg/m2 and mean waist circumference was 101 cm), 33% had a family history of premature CHD, and 21% were current smokers or quit within the last 12 months. Also 81% exercised below Australian Heart Foundation guidelines, 82.3% ate less than the daily recommendations of vegetables, and 49% ate less than the daily recommendations of fruit each day. Overall 81% had 2 or more CV risk factors, and the mean number of CV risk factors (diabetes, smoker, hypercholesterolaemia, hypertension, family history, CRF, known CHD, elevated waist circumference) was 2.8. Conclusions: Many patients referred to RACC with chest pain have a high burden of uncontrolled risk factors. Thus, RACCs may bring new opportunities for modifiable risk factor optimisation and cardiovascular disease prevention. http://dx.doi.org/10.1016/j.hlc.2017.06.112
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112 Recurrent 12-Month Myocardial Infarction Rates in Patients Discharged with Acute Coronary Syndrome: A Retrospective Analysis from a Regional Referral Centre F. Zaky ∗ , A. Ekmejian, O. Evans, C. Lynch, S. Dejanipont, P. Shetty The Wollongong Hospital, Wollongong, Australia Background: The Wollongong Hospital is a regional referral centre admitting approximately 900 Acute Coronary Syndromes (ACS) patients per year. Recent advances with potent thienopyridines has reduced recurrent ischaemia rates significantly, which has led to a consensus statement in recent guidelines. Our local policy continues to evolve, however current strategies use aspirin/clopidogrel as the main dual antiplatelet strategy post ACS. Methods: 886 patients presented to Wollongong Hospital with ACS between January and December 2016, most whom were discharged home on an aspirin/clopidogrel regimen. Medical records of these patients were retrospectively reviewed for recurrent myocardial infarction (MI) within one year. Data was collected on traditional coronary artery disease risk factors, previous revascularisation procedures, anti-platelet regimen, time to representation and subsequent requirement for re-vascularisation. Results: Of 886 patients presenting with ACS in 2016, 2.3% (n = 20) represented with an MI within one year. Of these 20 representations, 85% of patients (n = 17) were on aspirin and clopidogrel dual anti-platelet therapy. 95% (n = 19) of patients had prior re-vascularisation procedures, 55% (n = 11) through percutaneous coronary intervention (PCI). 55% (n = 11) of representations were managed medically after angiography, with 45% (n = 9) subsequently requiring bypass or PCI. Conclusion: Recent trials have shown that recurrent ischaemic rates are substantially higher in patients treated with aspirin/clopidogrel than combinations including more potent thienopyridines, however in our cohort re-presentation rates in patients on aspisin/clopidogrel were found to be very low, with a low requirement for subsequent procedural re-vascularisation. http://dx.doi.org/10.1016/j.hlc.2017.06.113